Follow a routine, they say. Sleep at the same time, they say. Really? How can a routine help me cope?

How can something like a routine help you manage bipolar disorder — a chronic condition marked by changes in thoughts, behaviors, moods … changes in seemingly everything.

“I take my medication in the morning when I wake,
Reminding me the value of the effort I must make,
My mental health could suffer if I don’t stay self-aware,
It’s vital that I always make the time for my self-care.”

— “My Recipe for Sanity“, Angela McCrimmon

When you’re experiencing the sudden shifts in mood and other symptoms, bipolar disorder can feel unpredictable and difficult. Sometimes, you might feel exhausted or frustrated, and learning your triggers is not an afternoon activity.

But while bipolar disorder (BD) is complex, it’s also highly manageable.

A key component to a good treatment plan is consistency — and that’s where a routine comes in. Creating a relatively simple routine can help you prioritize healthy activities and your mental health.

Daily routines and a consistent sleeping schedule can be powerful in helping you manage symptoms of bipolar disorder — there’s even a therapy developed around this called interpersonal and social rhythm therapy (IPSRT).

A study in 2020 found that IPSRT improved anxious, manic, and depressive symptoms of people with bipolar disorder.

This therapy is based on the belief that people with mood disorders often experience sleep and circadian rhythm disruption, which can trigger or worsen symptoms.

Past research — like these reviews from 2015 and 2017 — suggest that sleep deprivation may be a major trigger for symptoms of mania and depression.

But it’s not just sleep that needs consistency, either.

It’s important to work with a therapist or treatment team to prioritize what’s important for your daily self care. But if you’re not sure where to even start with a routine tailored to you? We’ve got you covered.

1. Taking your meds and supplements

Since medication is so highly effective for bipolar disorder, it’ll probably be the centerpiece of your routine.

“[Taking my medicine is] as second nature as brushing my teeth in the morning and at night,” says Elaina J. Martin, a writer with bipolar I disorder.

But while staying on track with your prescribed meds and doctor-approved supplements is essential — it can also be tricky to adjust and sometimes maintain.

When Martin first started taking medication, she found it helpful to use a pillbox to organize her pills for the morning, afternoon, and evening. To ensure she doesn’t forget, she also sets multiple alarms on her phone.

“Tell me more about this pillbox,” you say? Here are 6 of the best reminders for your meds.

2. Treating sleep like money

In other words, like your money, treat sleep as an invaluable, precious resource that you need to protect.

It’s easy to view getting enough sleep as a chore or annoying — but it’s so vital. It’s time to see sleep as an opportunity to function well and feel good.

For example, because lack of sleep is a trigger for Martin, she’s rarely up past 11 p.m. or before 8 a.m. “That’s a long sleep, but it is what my body needs so that is what I give it,” she says.

To prioritize sleep and actually make it happen, it’s important to follow sleep hygiene rules and effectively get past sleep saboteurs, such as racing thoughts.

Try these tips from Sheri Van Dijk, a psychotherapist and author who specializes in bipolar disorder:

Have an end-of-day routine

“Engaging in the same or similar activities at the end of the day will signal [to] your brain that the day is coming to an end and it’s almost time for bed,” Van Dijk says.

For example, your relaxing routine might include watching a favorite show, taking a hot bath, and meditating.

Pen down your pain points

Because worries can easily keep you up at night, reserve 10 to 15 minutes to write about them earlier in the evening.

Putting pen to paper can make your concerns feel less overwhelming and more manageable. You also might sketch out a few solutions for concerns you have control over.

Listen to relaxing music

To further calm racing thoughts, listen to music with nature sounds or ambient noise.

Do the waltz, with your breath

Deep breathing can bring great healing and calming benefits.

Box breathing takes shape by inhaling, holding, exhaling, and holding. Rinse and repeat, and you can signal your nervous system that it’s time to calm down and take off the anxiety hat.

Check out 4 failproof breathing techniques.

Create a sleep-friendly environment

Keep your bedroom clean, cool, dark, and quiet. That’s because light from electronic devices “tricks your brain into thinking it’s still daylight and will prevent deep sleep,” Van Dijk explains.

TV can be equally as disruptive, she adds: “Your unconscious mind is still processing what it hears, even if you’re not aware of it.”

If you have trouble sleeping in a completely silent space, try a white noise machine.

3. Establishing structure

When you have too much unstructured time on your hands, you might turn to activities that leave you feeling unproductive and unfulfilled and even sink your self-esteem, says Van Dijk. Think Netflix binges, doomscrolling, and online overspending.

What’s more, a lack of structure can spark anxious thoughts and steal time away from important activities (like sleeping!).

To create a healthy structured routine, start by considering nonnegotiable activities like:

  • eating
  • going to work
  • seeing your therapist
  • staying active
  • sleeping

Then, as much as possible, try to do these activities regularly, such as at the same times on most days.

For example:

  • Aim to eat at least 3 times a day.
  • Take walks or YouTube an indoor exercise you can make regular.
  • If you can, strive for the same bedtime and wake-up times.
  • Keep a standing appointment and try to meet with your therapist regularly. No news is good news! You don’t always have to have a “reason” to maintain therapy.

Lastly, try to add other purposeful, fulfilling activities, such as volunteering, talking to an online support group, and having dinner dates with friends.

If your daily or weekly schedule varies — because of your work, for instance — try to add structure and stability where you can. Life happens after all, and no one expects you to be a robot.

4. Tracking your symptoms on a calendar or planner

At first glance, mood episodes can seem to come on suddenly and randomly. But tracking your symptoms and habits can reveal important patterns for better managing your condition and even preventing episodes.

To start tracking, pick a paper planner, digital calendar, or an app.

Martin likes the app eMoods. It lets you chart your highs and lows, sleep, and medications and sends a report to your mental health pro (if you’d like). You can also ask your therapist or psychiatrist for recommendations.

Next, consider penning down the following throughout the day:

  • Diet: What you eat may affect your symptoms for better or worse. For example, alcohol and caffeine-packed foods and drinks can amplify anxiety and make it harder to sleep.
  • Mood: Be specific about how you’re feeling. To pinpoint your emotion, it can help to use an emotions wheel or list.
  • Seasonal and weather shifts: Research suggests that symptoms of bipolar disorder can fluctuate with seasonal and weather changes. For example, some people may start to experience depression in the wintertime and mania or hypomania during spring or summer.
  • Sleep: Note the number of hours you sleep, and when you go to bed and wake up. Sleeping too much or not enough can be a sign that a mood episode may be coming on.
  • Stressful events: Research suggests that stressful events may trigger episodes. A stressful event may be anything from moving, to arguing with your partner.
  • Other changes: Maybe you’re traveling, have the week off, or are working a different shift this week. Any change is important to note because it can affect your symptoms. For example, traveling to a different time zone can trigger an episode (but it’s also something you can manage).
  • Signs of delusions or hallucinations: During severe episodes, some people with bipolar disorder may experience psychosis. Signs of psychosis include seeing or hearing things that aren’t there, or having delusional beliefs.

Tracking these things can clue you into what triggers your mood changes and other symptoms — and what might even protect against them.

5. Setting unstructured time

While structure is needed for daily life with bipolar disorder, planning some unstructured, recreational time can also bring satisfaction and stability.

Start by carving out time for yourself on a regular basis and giving these ideas a try:

  • Find your (healthy) happy place. This might be anything from having a picnic at the park, to browsing your favorite bookstore or taking a walk on the beach.
  • Make space to meditate and reflect. Listen to a guided meditation. Practice your favorite yoga poses. Journal about what you’ve loved and learned about your day.
  • Prioritize play. Blogger Christina Chambers speaks of adding “play to your day” as a necessary part of your routine in managing bipolar disorder.

    Because play is personal, find what activities feel fun and lighthearted to you. You might paint with your kids, join an intramural league, watch quirky shows, or write children’s books.

Once you’ve set the foundation for managing bipolar disorder, your routine will need maintenance to stay solid. A car with regular servicing last a very long time!

Check in with an accountability partner

Enlist your support system to help you keep up your routine and manage your condition in general. Your support system might include a few trusted individuals, such as your partner, therapist, and best friend.

Martin talks daily with her mom, attends weekly coffee dates with a friend, and regularly sees her therapist.

Just having these built-in appointments is powerful. “Knowing that I have a time set aside to talk to someone about anything I am dealing with is a relief to me,” she says.

Stay disciplined with boundaries

Boundaries are vital for protecting your days and your mental health. Establishing boundaries with others also protects those you care about and have to work with. It’s a two-way street.

Boundaries for others might mean being cognizant that the listening ears in your support system also need to be heard or helped.

Boundaries for you could mean being thoughtful about the commitments you put on your calendar. Before saying yes to any activity, task, or event, consider whether it’s good for your mental, emotional, and physical well-being:

  • Will this stress you out?
  • Will you be overbooked?
  • Will there be social or interpersonal triggers present?
  • Will it lead to less sleep or a later bedtime?

Similarly, have a good idea of how many tasks you can take on along with how long it takes you to complete them.

Then, be kind and clear when saying no. Thank others for their invites and requests, but let them know you’re otherwise engaged.

Because life is life, your routine may get disrupted.

But thankfully, with the help of your treatment team, you can recover and reestablish your routine.

For example, after a mood or psychosis episode, your doctor might adjust your meds. Together, you and your therapist can reflect on what potentially triggered the episode and make a plan for the future.

While creating a routine when living with bipolar disorder can help symptom management — it’s really about boosting your overall well-being.

Whether it’s tracking your moods, taking your meds, or getting the Zzz’s you so need, a routine can help you feel more in control.